Background: Breast surgery is an exceedingly common procedure with an increased incidence of acute and chronic pain. Pectoral nerve block is a novel peripheral nerve block alternative to neuro-axial and paravertebral blocks for ambulatory breast surgeries. Objectives: This study aims to compare the analgesic efficacy and safety of modified Pecs block with ketamine plus bupivacaine versus bupivacaine in patients undergoing breast cancer surgery. Study Design: A randomized, double-blind, prospective study. Setting: Academic medical center. Methods: This study is registered at www.clinicaltrials.gov under number: (NCT02620371) after approval by the ethics committee of South Egypt Cancer Institute, Assuit University, Assuit, Egypt. Sixty patients aged 18 – 60 years scheduled for modified radical mastectomy were enrolled and randomly assigned into 2 groups (30 patients each): Control group patients were given ultrasound-guided, Pecs block with 30 mL of 0.25% bupivacaine only. Ketamine group patients were given ultrasound-guided, Pecs block with 30 mL of 0.25% bupivacaine plus ketamine hydrochloride (1 mg/kg). Patients were followed up for 48 hours postoperatively for vital signs, VAS score, first request of rescue analgesia and total morphine consumption, sedation score, and side effects. Results: Ketamine plus bupivacaine in Pecs block compared to bupivacaine alone prolonged the mean time of first request of analgesia (18.25 ± 1.98), (12.56 ± 2.64), respectively (P 0.001), reduced total morphine consumption (12.50 ± 4.63), (18.86 ± 6.28), respectively (P = 0.016). With no significant difference in hemodynamics, respiratory rate, oxygen saturation, VAS and sedation scores, and side effects observed between the 2 groups (P > 0.05). Limitations: This study is limited by its sample size. Conclusion: The addition of ketamine to modified Pecs block prolonged the time to first request of analgesia and reduced total opioid consumption without serious side effects in patients who underwent a modified radical mastectomy.

A non‑invasive marker is required for the diagnosis and follow-up of patients with bladder cancer. The aim of the current study was to evaluate the potential prognostic significance of serum osteoprotegerin (OPG), p53 protein and urine telomerase in patients with bladder cancer. For all patients, serum levels of OPG and p53 protein were determined using enzyme-linked immunosorbent assay (ELISA), and urine telomerase was assessed using a polymerase chain reaction ELISA technique. Patients were assigned into group 1 (cystectomy and adjuvant radiotherapy) or group 2 (transurethral resection and chemoradiotherapy). The results revealed that serum OPG and p53, and urine telomerase levels were significantly higher in bladder cancer patients compared with in healthy individuals (P0.0001). High serum OPG was associated with significantly lower overall survival and disease-free survival rates (both P=0.001), and was correlated with advanced tumor stages (P0.0001), high tumor grades (P0.0001) and the occurrence of disease relapse (P=0.001). Serum p53 and urine telomerase did not demonstrate prognostic significance. These findings indicate that serum OPG level may be used as a diagnostic tool and a prognostic variable for patients with muscle invasive bladder cancer. Future trials are required to elucidate its therapeutic role in such patients.

A non‑invasive marker is required for the diagnosis and follow-up of patients with bladder cancer. The aim of the current study was to evaluate the potential prognostic significance of serum osteoprotegerin (OPG), p53 protein and urine telomerase in patients with bladder cancer. For all patients, serum levels of OPG and p53 protein were determined using enzyme-linked immunosorbent assay (ELISA), and urine telomerase was assessed using a polymerase chain reaction ELISA technique. Patients were assigned into group 1 (cystectomy and adjuvant radiotherapy) or group 2 (transurethral resection and chemoradiotherapy). The results revealed that serum OPG and p53, and urine telomerase levels were significantly higher in bladder cancer patients compared with in healthy individuals (P0.0001). High serum OPG was associated with significantly lower overall survival and disease-free survival rates (both P=0.001), and was correlated with advanced tumor stages (P0.0001), high tumor grades (P0.0001) and the occurrence of disease relapse (P=0.001). Serum p53 and urine telomerase did not demonstrate prognostic significance. These findings indicate that serum OPG level may be used as a diagnostic tool and a prognostic variable for patients with muscle invasive bladder cancer. Future trials are required to elucidate its therapeutic role in such patients.

A non‑invasive marker is required for the diagnosis and follow-up of patients with bladder cancer. The aim of the current study was to evaluate the potential prognostic significance of serum osteoprotegerin (OPG), p53 protein and urine telomerase in patients with bladder cancer. For all patients, serum levels of OPG and p53 protein were determined using enzyme-linked immunosorbent assay (ELISA), and urine telomerase was assessed using a polymerase chain reaction ELISA technique. Patients were assigned into group 1 (cystectomy and adjuvant radiotherapy) or group 2 (transurethral resection and chemoradiotherapy). The results revealed that serum OPG and p53, and urine telomerase levels were significantly higher in bladder cancer patients compared with in healthy individuals (P0.0001). High serum OPG was associated with significantly lower overall survival and disease-free survival rates (both P=0.001), and was correlated with advanced tumor stages (P0.0001), high tumor grades (P0.0001) and the occurrence of disease relapse (P=0.001). Serum p53 and urine telomerase did not demonstrate prognostic significance. These findings indicate that serum OPG level may be used as a diagnostic tool and a prognostic variable for patients with muscle invasive bladder cancer. Future trials are required to elucidate its therapeutic role in such patients.

Background: Bladder cancer constitutes 30% of all cancer patients, for whom a non-invasive marker is, required for the follow-up and diagnosis and follow up. Aim: Evaluation of the potential prognostic significance of serum osteoprotegerin (OPG), and pS3 protein and urine telomerase in patients with bladder cancer. Methods: For all patients, serum levels of OPG and pS3 protein were determined using ELISA and urine telomerase by PCR ELISA technique. Patients were then assigned into group1 (cystectomy and adjuvant radiotherapy) and group2 (TUR and chemoradiation). Results: Serum OPG and p53 levels and urine telomerase were significantly higher in bladder cancer patients than in healthy individuals. (p 0.0001). High serum OPG was associated with significantly lower OAS and DFS rates (p=0.001), and was correlated with advanced T stages (p0.0001), high grades (p0.0001) and presence of disease relapse (p=0.001).Serum p53 and urine telomerase did not show prognostic significance. Conclusions: Serum OPG level may be used as a diagnostic tool and a prognostic variable in patients with muscle invasive bladder cancer. Future trials are needed to elucidate its therapeutic role in those patients.

Background: Bladder cancer constitutes 30% of all cancer patients, for whom a non-invasive marker is, required for the follow-up and diagnosis and follow up. Aim: Evaluation of the potential prognostic significance of serum osteoprotegerin (OPG), and pS3 protein and urine telomerase in patients with bladder cancer. Methods: For all patients, serum levels of OPG and pS3 protein were determined using ELISA and urine telomerase by PCR ELISA technique. Patients were then assigned into group1 (cystectomy and adjuvant radiotherapy) and group2 (TUR and chemoradiation). Results: Serum OPG and p53 levels and urine telomerase were significantly higher in bladder cancer patients than in healthy individuals. (p 0.0001). High serum OPG was associated with significantly lower OAS and DFS rates (p=0.001), and was correlated with advanced T stages (p0.0001), high grades (p0.0001) and presence of disease relapse (p=0.001).Serum p53 and urine telomerase did not show prognostic significance. Conclusions: Serum OPG level may be used as a diagnostic tool and a prognostic variable in patients with muscle invasive bladder cancer. Future trials are needed to elucidate its therapeutic role in those patients.

Background: Bladder cancer constitutes 30% of all cancer patients, for whom a non-invasive marker is, required for the follow-up and diagnosis and follow up. Aim: Evaluation of the potential prognostic significance of serum osteoprotegerin (OPG), and pS3 protein and urine telomerase in patients with bladder cancer. Methods: For all patients, serum levels of OPG and pS3 protein were determined using ELISA and urine telomerase by PCR ELISA technique. Patients were then assigned into group1 (cystectomy and adjuvant radiotherapy) and group2 (TUR and chemoradiation). Results: Serum OPG and p53 levels and urine telomerase were significantly higher in bladder cancer patients than in healthy individuals. (p 0.0001). High serum OPG was associated with significantly lower OAS and DFS rates (p=0.001), and was correlated with advanced T stages (p0.0001), high grades (p0.0001) and presence of disease relapse (p=0.001).Serum p53 and urine telomerase did not show prognostic significance. Conclusions: Serum OPG level may be used as a diagnostic tool and a prognostic variable in patients with muscle invasive bladder cancer. Future trials are needed to elucidate its therapeutic role in those patients.

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